Unrelated umbilical cord blood transplantation in adult patients

Abstract

Since January 1996, we have administered myeloablative therapy followed by infusion of unrelated umbilical cord blood cells in 57 adult patients with high-risk disease. The median age was 31 years (range, 18-58 years), and the median weight was 70 kg (range, 46-110 kg). Two patients were treated for genetic disorders and 55 for advanced hematologic malignancies. The preparative regimens were total body irradiation or busulfan based, both with antithymocyte globulin. HLA matching between donor and recipient was 3 of 6 in 3 patients, 4 of 6 in 44 patients, 5 of 6 in 8 patients, and 6 of 6 in 2 patients. The median nucleated cell dose was 1.50 x 10(7)/kg (range, 0.54-2.78 x 10(7)/kg), and the median CD34(+) cell dose was 1.37 x 10(5)/kg (range, 0.02-12.45 x 10(5)/kg). All patients received granulocyte colony-stimulating factor after transplantation until neutrophil recovery. Graft-versus-host disease prophylaxis consisted of cyclosporine and steroids. The median number of days to an absolute neutrophil count of 500/microL was 26 (range, 12-55 days). The median time to an untransfused platelet count of >20000/microL was 84 days (range, 35-167 days). Seventeen patients developed grade II to IV acute GVHD. The median survival of the entire group was 91 days (range, 10-2251 days). Eleven patients were alive at a median follow-up of 1670 days (range, 67-2251 days), 1 with autologous recovery and 1 with relapsed lymphoma. The actuarial projected 3-year survival is 19%. Infection was the primary cause of death. These results suggest that unrelated umbilical cord blood transplantation is a viable option for adult patients and should be explored in patients with earlier-stage disease.

Unrelated cord blood transplantation in pediatric patients: a report from Saudi Arabia

“…The different genetic background of the transplanted units did not seem to adversely affect the outcome in our patients; our engraftment rate is 93% and our 100-TRM is 15%, conforming to already published data. 1,[3][4][5][6]15,16 In the malignant disorder category, we report in this study an estimated OS and EFS of 41 and 38%, respectively, and others also have reported similar figures. 7,9,15 The degree of HLA disparity seemed to have an effect on the survival of patients with non-malignant hematological disorders, as has been shown by Gluckman et al 3 in Fanconi anemia (FA) patients, although others failed to show such an effect in patients with severe aplastic anemia.…”

Umbilical cord blood transplantation: Basic biology and clinical challenges to immune reconstitution

“…In a registry-based retrospective study of 682 patients, Rocha et al [13] found both the rate of acute and chronic GvHD in mismatched UCB patients to be lower than the rates in matched BM recipients. However, the relationship between the relatively small cell dose found in UCB units and the delay in engraftment times and subsequent immune reconstitution for neutrophils and platelets continued to be problematic [13,15,17,18]. Long et al [17] noted that infection was the primary cause of death in their study of 57 adults with high-risk disease who were transplanted with unrelated UCB.…”

“…However, the relationship between the relatively small cell dose found in UCB units and the delay in engraftment times and subsequent immune reconstitution for neutrophils and platelets continued to be problematic [13,15,17,18]. Long et al [17] noted that infection was the primary cause of death in their study of 57 adults with high-risk disease who were transplanted with unrelated UCB. A large multicenter prospective study of UCB transplantation in adults found that in 34 patients 90% experienced infections; two thirds of those studied reported at least 3 infections during the first 6 months post-transplant [19].…”

Cord blood transplantation in adults

“…As a result of the early successes with pediatric cord blood transplantation (CBT), cord blood from unrelated donors has been increasingly used as an alternative stem cell source for adult patients with hematological malignancies. [1][2][3][4][5][6][7][8][9][10][11][12][13] Recently several reviews including the clinical results of adult CBT have been published. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In this review, we focus on recent results of myeloablative CBT in adults.…”